e-Health -- new year imponderables

I had occasion to visit my local walk-in-clinic over the holidays and as usual, took the opportunity to observe what was going on around me; it was 08:00 on a Sunday and the waiting room was packed within 5 minutes of the doors being opened.
As I sat there, a slew of questions began forming in my mind, such as:

• why do doctors' offices close -- do we really think illnesses follow the concept of a "work-day/week" and observe statutory holidays?
• why do we still refer to the "family doctor", as if the latter is obligated to stay around to serve us until we depart planet Earth?
• why does the Ministry of Health (MOHLTC) seek so desperately to reduce hospital emergency room wait times, yet apparently has no coordinated plans to ensure 24/7 primary healthcare provider (HCP) coverage?
• why is the MOHLTC gung-ho on the EMR, yet we hardly hear any discussion on electronically linking healthcare facilities so patient data can easily be shared?

Of course, I not only thought about the questions/issues -- heck, I tried to solve them all by myself!

For example, I'm thinking that:

• using the FHT concept, primary HCP clinics should be staffed 24/7 and managed by the LHIN for any given area
• a hospital's emergency department should be for life-threatening situations only -- if you can get there under your own steam, you should really be visiting a primary HCP clinic
• we need to stop this nonsense about ownership of patients' records -- the latter should be electronically stored and managed by the LHIN with access allowed as appropriate (patients included); do we hyperventilate about ownership of our tax/banking/insurance records? Patients' records should simply be one of the tools used by HCPs/the MOHLTC to help provide best-of-breed care for Ontario residents

The more time we spend debating this, the closer we'll get to privatization (yes, I finally said the "p" word) -- there's no way our taxes can sustain the level of spending our healthcare system requires, for any appreciable length of time -- something's gotta give!

I'm hoping an election year will help spur on some badly-needed changes.

Wishing you the best for 2011.


Ernest A. James

President & CEO
Regal Informatics Inc.

e-Health -- a moment of clarity

I had the opportunity to attend the October session of the CE LHIN board meetings and I must confess to leaving the latter with a quizzical look and my mind running in overdrive; the Project Management Office gave an excellent overview of what the "rubber hitting the road" was like for them -- the latter was actually an inspiration for the previous post, in that I feel we need to hear more of the experiences of the folks on the front lines.

During the afore-mentioned presentation, I thought I heard something to the effect that efforts at implementing the various e-Health initiatives (such as a data center consolidation amongst the LHINs) were being stymied by the various hospitals bringing along their lawyers to the meetings.
On the way home, I began beating up on myself for not listening more attentively, for I determined there was no way LHINs could be shooting themselves in the foot by funding lawyers to, at best, slow down the progress being made with their projects, or so I thought...

Fast forward to November 30th, 2010 -- I was vegetating in front of the TV after a hectic day; flicking through the channels during commercials, I came across a TVO episode entitled "Patient-Centered care".
I quickly got back into listening mode and was taken aback at what I was hearing; stuff like "turf wars" amongst Healthcare Providers (HCPs) was vigorously being debated.
Elinor Caplan, a former Minister of Health for Ontario described one of her experiences that really had me shaking my head -- basically, she had met with two hospital boards that were planning the implementation of e-Health systems and pleaded with them to at least ensure compatibility was included in their specifications.
What did the hospitals do? They ignored her request, shored up their turf and ended up with systems that couldn't "talk" to each other, in effect creating more islands of information.

I have always contended that the state of e-Health in Ontario was not due to any lack of technology or security (systems that allow us online access to our income taxes or banking information are solid testaments), so the above discussions really put things into perspective for me.

So, what will it take to get some movement away from this "my patient data" way of thinking? Well, one way or another, it's got to happen.
Now, I'm not optimistic that HCPs will become altruistic and voluntarily begin sharing their data overnight, so I suspect we'll see something mandated by early 2012, at the latest.
I think we've had enough discussion -- it's now time for action -- the current state of affairs is unsustainable.

I wish you a safe and joyous holiday season and look forward to one interesting year ahead.


Ernest A. James

President & CEO
Regal Informatics Inc.